telemedicine5103 - Ethical Challenges of Telemedicine and Telehealth

Article Link

Kaplan, B., & Litewka, S. (2008). Ethical challenges of telemedicine and telehealth. Cambridge Quarterly of Healthcare Ethics : CQ : The International Journal of Healthcare Ethics Committees, 17(4), 401-416. doi:10.1017/S0963180108080535

Potential benefits of telehealth and telemedicine:
Patients seem to get what they want/need - personalized access to providers, targeted information to their needs, interactive tools for health and disease management
- Greater availability of services and access to healthcare providers (including specialty services that are location-limited)
- Reduced disparities in healthcare accessibility
- Less travel time for both patient and clinician
- Lower costs
- Quality improvements deriving from increased access to more timely and accurate data
Patients become empowered - they have more access to information, can stay in their home, have reduced power differential with providers - could interact with a larger community and form a patient-based “community of practice”
More continual monitoring of patient data could lead to increased peace of mind for all involved - clinicians, patients, family members
Little thought has been given to ethical issues of telehealth/telemedicine - time is running out to address such ethical as, telehealth/medicine continues to progress regardless of regulation/legislation
Major ethical concerns:
- Privacy issues re: data mining
- Inaccurate/obsolete data
- Quality and accuracy of online information
- Usability/obtrusiveness of technology
- Each creator-stakeholder has its own motivations (social, economic, professional) - unclear if there is alignment
- How provider vs. patient centric is the technology?
- Are the values of rural communities being sacrificed in the face of efficiency?
- Centralized, remote specialist consults (e.g. radiologists) are unable to obtain the full picture of the patient’s situation by having an ongoing relationship with the rest of the provider team
- There may be an overwhelming amount of de-contextualized data that providers must sift through - may lead to an increase in error
- Not clear whose responsibility it is to respond to changes in baseline vitals data - processes/chain of responsibility has not been established
- Onset of significant technological shift changes how we approach informed consent - do we have a responsibility to fully inform patients of the potential drawbacks of technological interventions
- Some social implications may be impossible to predict - for example, in one automated telehealth program, some participants described the voice on the telephone as “the doctor”, “a friend”, “a mentor”, and reported developing strong feelings of attachment - should people be advised about the possibility of forming psychological or emotional attachments with them?
- Are people being encouraged to take an active role in their own health, or being manipulated into changes in behaviour (i.e. paternalism in a new package) - should we be especially sensitive to this in light of other seemingly well-meaning interventions that span cultures and ethnicities? (e.g. residential schools in aboriginal communities)
- Proponents of telehealth cite freedom and independence for aging individuals - however, is it possible that the technology is leading to further isolation? For example, the medical appointments, check ins with neighbours, visits from concerned children, may provide a social network that ultimately leads to better physical and mental health